PhilHealth benefits not maximized

DEAR Aksyon Line,

My child is a Reservist of AFP. On February 23, 2016 while working as an OJT in Camp Aguinaldo, she felt severe stomach pain. She was rushed in Camp Aguinaldo’s Clinic but unfortunately the doctor was not available. She was referred to AFP Medical Center in V. Luna, Quezon City. She was diagnosed and recommended to undergo appendectomy. Before the operation, I was advised that only active soldiers are usually accommodated by the hospital unless guaranteed by an active soldier. Fortunate enough, the confinement of my child was guaranteed by a soldier from ARESCOM Unit.

The thing is I have to buy medicine and the materials to be used in the operation outside the hospital because the Pharmacy inside AFP Medical Center claimed that the supply and medicines are exclusive for certified soldiers only. Since my child needs an immediate operation, I bought everything outside the hospital that costs more or less Ten Thousand Pesos (Php 10,000.00). My problem is I was not able to maximize the benefit for this confinement. What should I do to process the reimbursement for medicines?

Your immediate action is very much appreciated.

Sincerely yours,
Helen H. Gonzalez
HR Officer
REPLY: Dear Madam:

Greetings from Team PhilHealth!

Please be informed that PhilHealth implemented the All Case Rates, a payment mechanism wherein all cases are compensated through a defined packaged rate. Case rate payments shall cover for the Professional fee & all Health Care Institution charges including but not limited to room & board, diagnostics & laboratories, drugs, medicines & supplies, operating room fees, & other fees & charges.

Any amount on top of the Case Rate will be subject to co-pay or out of pocket of the member.

In cases wherein members were not able to maximize the amount of package and were advised to purchase medicines and other supplies outside of the facility, we would suggest that you submit the official receipts to the hospital as they will be the one to file the claim documents to PhilHealth.

Once the claim is already paid, the member may request for a copy of the Benefit Payment Notice from PhilHealth office and coordinate with the hospital for the evaluation and release of his/her refund to be issued by the hospital.

For more concerns and other queries you may e-mail us again or call our action center hotline at 441-7442.

You may also visit our website at www.philhealth.gov.ph

Thank you.
Warm regards,

CORPORATE ACTION CENTER
Website: www.philhealth.gov.ph
Twitter: @teamphilhealth
Facebook: www.facebook.com/PhilHealth
Call Center: 441-7442

May nais ba kayong isangguni sa Aksyon Line? Maaari kayong sumulat sa aming tanggapan Aksyon Line c/o Inquirer Bandera, MRP bldg., Mola st. cor. Pasong Tirad st., Makati City o kaya ay mag-email sa [email protected], [email protected] or jenniferbilog97@ gmail.com.
Hangad ng Aksyon Line na buong puso namin kayong mapaglingkuran sa abot ng aming makakaya.